Rheumatoid arthritis with tibial deviation of the toes

Case contributed by Dr Matt Skalski

Presentation

Long-standing joint pains and deformities of the fingers and toes.

Patient Data

Age: 65 years
Gender: Female

There are multiple angular deformities of the toes, with tibial deviation and flexion deformities at all of the metatarsophalangeal joints bilaterally. Pes planus is also noted bilaterally. Joint spaces appear preserved. 

Hitch hiker thumb and swan neck deformities are noted bilaterally. The "hook-like" osteophytes at the metacarpal heads increase suspicion for hemochromatosis. No erosive changes are seen. 

Case Discussion

Tibial deviation or reverse lanois deformity of the toes is a seldom-seen abnormality, and the findings, in this case, are atypical for rheumatoid arthritis, but none-the-less consistent with the diagnosis which was known in this patient. With alignment deformities and a lack of bony erosion Lupus and Jaccoud arthroptahy should be primary considerations in absence of serologic and clinical data. Well managed Rheumatoid arthritis, as in this case, may present without erosions. 

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Case information

rID: 29880
Published: 29th Jun 2014
Last edited: 2nd Sep 2019
Inclusion in quiz mode: Included

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